Implementing a smoking cessation training for lower socioeconomic groups into local policy in Amsterdam, the Netherlands: Identifying preconditions and barriers among multiple stakeholder groups

Abstract Background Socioeconomic inequalities in smoking prevalence are high, partly because smoking cessation programs are insufficiently accessible and suitable for smokers with a lower socioeconomic position (SEP). To make it easier for this target group to access suitable smoking cessation programs, it is necessary to structurally implement such programs into local policies. The study aims to identify preconditions and barriers for the implementation of smoking cessation programs for people with low SEP from the perspective of key stakeholders. Methods The Feel Free! Smoking cessation rolling group training has been previously developed for people from lower socio-economic groups and was implemented in Amsterdam Noord. Semi-structured interviews were held with 25 stakeholders consisting of participants, trainers, professionals in the neighbourhood and stakeholders of the municipality. The interviews were audio-recorded, transcribed verbatim and analysed using a thematic approach. The Implementation Framework of Fleuren will be used to structure the presentation. Results The main preconditions found are effective recruitment of participants by local professionals, having a central coordinator for implementation within the neighbourhood network, and offering a smoking cessation program with a clear added value for participants. The main barriers found are challenges in setting up a sustainable financial structure, allocation of organizational tasks, and high participant absences and dropout. More results will be presented in detail. Conclusions This study shows that action is required from various stakeholders to facilitate the implementation process. These findings can inform policy makers and implementers to choose strategies to implement suitable smoking cessation programs into local policy.


Background:
After implementation of a tobacco vending machine ban in 2022 and a supermarket sales ban in 2024, the Dutch government intends to further phase out tobacco sales after 2030 by prohibiting sales in petrol stations and small outlets. This study aims to understand 1) the impact of these policies on tobacco outlet availability, and 2) differences in tobacco outlet availability by area socioeconomic status (SES) in the Netherlands.

Methods:
Between September 2019 and June 2020, all potential tobacco retailers in four Dutch cities (Amsterdam, Eindhoven, Haarlem, and Zwolle) were visited and mapped using Global Positioning System (GPS). Expected reductions in tobacco outlet availability were calculated per policy measure. Tobacco outlet density was calculated using ESRI ArcMap version 10.4.1. The association between neighbourhood SES and tobacco outlet availability was estimated with linear and logistic regression model.

Conclusions:
The availability of tobacco outlets varies within and between cities depending on the distribution of the built environment. Future tobacco control policies targeting the retail environment should focus on limiting the overall number tobacco outlets and especially small outlets, which may benefit low SES neighbourhoods in mid-sized cities most.
Abstract citation ID: ckac129.755 Impact of smoke-free policies in hospitality venues and the home environment on smoking behaviour and exposure to second-hand smoke: results of two systematic reviews

Background:
Smoke-free policies (SFPs) have proven to be effective in protecting people from exposure to second-hand smoke (SHS) and lowering smoking rates. Our aims were to assess the impact of SFPs in hospitality venues (e.g. bars) on smoking behaviour of young people and to assess the impact of SFPs in the home environment on smoking behaviour and exposure to SHS. Methods: Two reviews were conducted. The first was conducted in June 2020. We searched PubMed, Embase, and Scopus for studies that assessed the association between any form of SFPs in hospitality venues and a measure of smoking behaviour among young people (aged 10-24 years). The second review will be conducted in June 2022. Searches will be conducted in PubMed, Embase, Web of Science, PsycINFO and CENTRAL. We will search for studies that assess the association between any form of SFPs in the home environment (e.g. multi-unit housing) and a measure of smoking behaviour (e.g. initiation) or SHS exposure.

Results:
Nine studies (publication years 2005-2016) were included in the first review, of which the majority used a quasiexperimental design. Four studies evaluated SFPs in hospitality venues specifically. Two studies reported that strict, but not weaker, SFPs decrease progression to established smoking. Two other studies provided mixed results. Five studies also included other workplaces, of which three studies found significant decreases in current smoking, smoking frequency, and/or smoking quantity. The results of the second review will be presented in detail during the workshop, however an exploration suggests that SFPs in the home environment may prevent smoking and SHS exposure.

Conclusions:
Most studies of the first review found that SFPs in hospitality venues are associated with a decrease in smoking behaviour among young people. Their results indicate the need for strict smoke-free legislation without exemptions. The conclusions of the second review will be presented during the workshop.
The study aims to identify preconditions and barriers for the implementation of smoking cessation programs for people with low SEP from the perspective of key stakeholders.

Methods:
The Feel Free! Smoking cessation rolling group training has been previously developed for people from lower socioeconomic groups and was implemented in Amsterdam Noord. Semi-structured interviews were held with 25 stakeholders consisting of participants, trainers, professionals in the neighbourhood and stakeholders of the municipality. The interviews were audio-recorded, transcribed verbatim and analysed using a thematic approach. The Implementation Framework of Fleuren will be used to structure the presentation.

Results:
The main preconditions found are effective recruitment of participants by local professionals, having a central coordinator for implementation within the neighbourhood network, and offering a smoking cessation program with a clear added value for participants. The main barriers found are challenges in setting up a sustainable financial structure, allocation of organizational tasks, and high participant absences and dropout. More results will be presented in detail.

Conclusions:
This study shows that action is required from various stakeholders to facilitate the implementation process. These findings can inform policy makers and implementers to choose strategies to implement suitable smoking cessation programs into local policy.

11.Q. Pitch presentations: Monitoring the burden of disease
The majority of emerging infectious diseases are zoonoses, most of which are classified as ''neglected''. By affecting both humans and animals, zoonoses pose a dual burden. The disability-adjusted life year (DALY) metric quantifies human health burden using mortality and morbidity. This review aims to describe and analyze the current state of evidence on the burden of neglected zoonotic diseases (NZDs) and start a discussion on the current understanding of the global burden of NZDs. We identified 26 priority NZDs through consulting the CDC One Health Zoonotic Disease Prioritization Exercise, the Joint External Evaluation reports, and the WHO roadmap for NTDs. A systematic review of global and national burden of disease (BoD) studies for these priority NZDs was conducted using pre-selected databases. Data on diseases, location and DALYs were extracted for each eligible study. A total of 1887 records were screened, resulting in 72 eligible studies (58 national or sub-national, 12 global, and 2 regional studies). The highest number of BoD studies was found for non-typhoidal salmonellosis (23), whereas no estimates were found for West Nile, Marburg and Lassa fever. Geographically, the highest number of studies were found in the Netherlands (11), China (5) and Iran (4). The number of BoD studies retrieved mismatched the perceived importance in national prioritization exercises. For example, anthrax was considered a priority NZD in 73 countries, but only one national estimate was retrieved. By summing the available global estimates, these diseases would cause at least 10 million DALYs in total. The burden of NZDs at the global level remains scattered, and trends were challenging to identify. There are several priority NZDs for which no burden estimates exist, and the number of BoD studies does not reflect national disease priorities. To have complete and consistent estimates of the global burden of NZDs, these diseases should be integrated into larger global BoD initiatives.

Key messages:
There is a mismatched between the estimated retrieved in the search and the perception of the importance of these disease. This amplify the need for a comprehensive program.

Introduction:
For decades, people's body weight has been increasing at alarming rates, leading to a worldwide obesity epidemic. One of the main causes of this obesity epidemic is poor diet quality. The food environment has been suspected to be one of the principal drivers of poor diet quality. Older people and families with a poor socioeconomic background can be disproportionately affected.

Methods:
This study maps the food environment in Flanders between 2008 and 2020 by using the concepts of food deserts and food swamps. Food deserts have been defined as neighborhoods that lack access to some or all foods that are required for a balanced, nutritionally adequate diet. Food swamps refer to places where there is an abundance of unhealthy food options relative to healthy food options. A spatial analysis using population-and retail density datasets yielded the change in food deserts and swamps between 2008 and 2020.

Results:
Food deserts in Flanders are found to be small in area and very localized. While food deserts in areas with the two highest deciles of people older than 65 years increased from 1.3% to 1.6% of total surface area in Flanders between 2008 and 2020, the food deserts in areas with the two lowest deciles of low income families decreased from 4% to 2.4%. Food swamps in 15th European Public Health Conference 2022